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In atypical presentations, ultrasonography may be helpful to confirm the diagnosis of acute generalized peritonitis. Our study aimed to evaluate its accuracy at Albert Royer National Children’s Hospital Centre of Dakar, in Senegal. We conducted a two-year (2018-2020) retrospective cross-sectional study, with an analytical aspect. Fifty-one patients were included in our study. In 56.7% of cases, a radiologist realized the ultrasonography. The sensibility and specificity of ultrasonography for the diagnosis of acute generalized peritonitis were 70 and 75% respectively. Accuracy of diagnosis was reduced proportionally to the operator's experience, ranging from 82% for radiologists, 66% for interns in radiology to 46% for trainees in radiology (p=0,0145). In our environment, the accuracy of ultrasonography for the diagnosis of acute generalized peritonitis is poor, and largely influenced by the operator's experience, which relegates this investigation to the second line, behind clinical suspicion.

BACKGROUND Care plans are central to effective care delivery for people with multiple chronic conditions. But existing care plans—which typically are difficult to share across care settings and care team members—poorly serve people with multiple chronic conditions, who often receive care from numerous clinicians in multiple care settings. Comprehensive, shared electronic care (e-care) plans are dynamic electronic tools that facilitate care coordination and address the totality of health and social needs across care contexts. They have emerged as a potential way to improve care for individuals with multiple chronic conditions. OBJECTIVE To review the landscape of e-care plans and care plan–related initiatives that could allow the creation of a comprehensive, shared e-care plan and inform a joint initiative by the National Institutes of Health and the Agency for Healthcare Research and Quality to develop e-care planning tools for people with multiple chronic conditions. METHODS We conducted a scoping review, searching literature from 2015 to June 2020 using Scopus, Clinical Key, and PubMed; we also searched the gray literature. To identify initiatives potentially missing from this search, we interviewed expert informants. Relevant data were then identified and extracted in a structured format for data synthesis and analysis using an expanded typology of care plans adapted to our study context. The extracted data included (1) the perspective of the initiatives; (2) their scope, (3) network, and (4) context; (5) their use of open syntax standards; and (6) their use of open semantic standards. RESULTS We identified 7 projects for e-care plans and 3 projects for health care data standards. Each project provided critical infrastructure that could be leveraged to promote the vision of a comprehensive, shared e-care plan. All the e-care plan projects supported both broad goals and specific behaviors; 1 project supported a network of professionals across clinical, community, and home-based networks; 4 projects included social determinants of health. Most projects specified an open syntax standard, but only 3 specified open semantic standards. CONCLUSIONS A comprehensive, shared, interoperable e-care plan has the potential to greatly improve the coordination of care for individuals with multiple chronic conditions across multiple care settings. The need for such a plan is heightened in the wake of the ongoing COVID-19 pandemic. While none of the existing care plan projects meet all the criteria for an optimal e-care plan, they all provide critical infrastructure that can be leveraged as we advance toward the vision of a comprehensive, shared e-care plan. However, critical gaps must be addressed in order to achieve this vision.

Background: Most countries in Subsaharan Africa have well-established National Tuberculosis Control Programs with relatively stable routine performances. However, major epidemiological events may result in significant disruptions. In March 2014, the World Health Organization announced the outbreak of Ebola virus disease in Guinea, a country with a high incidence of TB and HIV. Our study aims to assess the impact of the Ebola virus disease outbreak on TB notification, treatment and surveillance, using main indicators.Methods: This is a retrospective cohort study that compares TB trends using surveillance data from the periods before (2011-2013), during (2014-2016) and after (2017-2018) Ebola virus disease outbreak. A time series analysis is conducted to investigate the linkages between the decline in TB notification and the Ebola virus disease outbreak through cross-correlation. The lag in the cross-correlation test is evaluated using ANCOVA type II delayed variable dependent model. The surveillance system is assessed using TB surveillance standards and benchmarks and vital registration systems recommended by WHO, compared with those of 2015 during the Ebola virus disease.Results: The rate of reporting of TB declined from 120 cases per 100,000 in 2011 to 100 cases per 100,000 in 2014, at the peak of the Ebola virus disease outbreak. The time series cross-correlation test of all notified cases of TB and Ebola shows a significant lag of -0.4 (40%), reflecting a drop in the rate of notification (F-value=5.7 [95% CI: 0.2-21.3]). However, the Ebola virus disease had no negative impact on patient treatment outcomes (F-value=1.3 [95% CI: 0.002-8.8179]). Regarding the surveillance system, five out of 13 WHO standards and benchmarks were met following their evaluation in 2019, after the Ebola virus disease outbreak, compared to three in 2015.Conclusion: Major epidemics such as the Ebola virus disease outbreak may have a significant impact on well-established TB control programs as shown in the example of Guinea. On the other hand, it is noticed that, sudden disruptions of routine performance may lead programs to improve their surveillance system.

Background: Acute intestinal intussusception (AII) is defined as the telescoping of part of the intestine into the intestinal segment beneath it. The consequence is an obstruction and strangulation which can lead to necrosis of the intestinal tract that has telescoped. The aim of our work is, on the one hand, to assess our management style throughout analysis of clinical different aspects and on the other hand to set up a strategy for early diagnosis and treatment. Methods: It is a retrospective study over 5 years from 2010 to 2015 including infants and children who had been treated for AII in Albert Royer Children's Hospital. The following variables such as age, sex, past time before the surgical consultation, initial diagnosis, imaging data view, treatment technique and results were itemised to bear comparison. Sixty-six records were reviewed. Results: The mean age was 5.73 months with a range of 2 and 144 months. Boys constituted the majority of patients with a ratio of 2:1. Children were referred to us with the diagnosis of intestinal obstruction or gastroenteritis in 50% of cases. Past time average before consultation was 5.3 days with a range of 14 h and 30 days. Most of the patients underwent surgery within 48 h after the beginning of the clinical picture. An abdominal ultrasound scan confirmed the diagnosis of AII in 57 cases, whereas in 9 cases, it was normal or not contributive. Non-operative reduction by retrograde pneumatic pressure or barium enema represented 33.4% of patients against 56.6% for surgical treatment. We registered 5 deaths and 2 recurrences. AII remains the main cause of intestinal obstruction in infants. Conclusion: Authors stressed on delay in diagnosis with the treatment consequences belonging to that status and put emphasis in the importance of close collaboration between paediatricians, surgeons and radiologist for early diagnosis and nonoperative systematic reduction.

Setting Since August 2016, after the Ebola outbreak, the Guinean National Tuberculosis Programme and Damien Foundation implemented the shorter treatment regimen (STR) for multidrug-resistant tuberculosis (MDR-TB) in the three MDR-TB sites of Conakry. Previously, the longer regimen was used to treat MDR-TB. Objectives In a post-Ebola context, with a weakened health system, we describe the MDR-TB treatment uptake, patients characteristics, treatment outcomes and estimate the effect of using the longer versus STR on having a programmatically adverse outcome. Design This is a retrospective cohort study in RR-TB patients treated with either the longer regimen or STR. Results In Conakry, in 2016 and 2017, 131 and 219 patients were diagnosed with rifampicin-resistant tuberculosis (RR-TB); and 108 and 163 started treatment, respectively. Of 271 patients who started treatment, 75 were treated with the longer regimen and 196 with the STR. Patients characteristics were similar regardless of the regimen except that the median age was higher among those treated with a longer regimen (30 years (IQR:24–38) versus 26 years (IQR:21–39) for the STR. Patients treated with a STR were more likely to obtain a programmatically favorable outcome (74.0% vs 58.7%, p = 0.01) as lost to follow up was higher among those treated with a longer regimen (20.0% vs 8.2%, p = 0.006). Patients on a longer regimen were more than 2 times more likely (aOR: 2.5; 95%CI:1.3,4.7) to have a programmatically adverse outcome as well as being 45 years or older (aOR: 2.8; 95%CI:1.3,6.2), HIV positive (aOR:3.3; 95%CI:1.6,6.6) and attendance at a clinic without NGO support (aOR:3.0; 95%:1.6,5.7). Conclusion In Guinea, patients treated with the STR were more likely to have a successful outcome than those treated with the longer MDR-TB treatment regimen. Lost to follow-up was higher in patients on the longer regimen. However, STR treatment outcomes were less good than those reported in the region.

Background Sputum smear and culture examination were used as bacteriological marker to monitor multidrug-resistant tuberculosis (MDR-TB) treatment. We aimed to identify the strongest contributing factors that affect time-to sputum bacteriological conversion, and to develop a practical risk scoreMethods Patients treated with shorter MDR-TB treatment regime between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centres in Guinea, who had a positive smear or culture at baseline, and who had rifampicin resistance were analysed. Sputum bacteriological conversion was defined as two consecutive negative smear or culture taken at least 30 days apart. Cox regression model was used to analyse time-to initial sputum conversion, and to identify influencing factors. A simple risk score was constructed using the regression coefficients from each final model. Time-dependent AUC was used to determine the optimal time points of bacteriological conversion.Results 75% (173/232) of patients with a positive smear and culture at baseline were analyzed. A total, 90.2% (156/173) and 89% (154/173) of the patients had smear and culture conversions in a median of 59 days (inter-quartile range: 59 – 61) respectively. Lower colony count (< 3 +) of initial culture (aHR = 1.52, 1.09 – 2.14) and previously history of TB treatment (aHR = 2.10, 1.26 – 3.51) were more likely to have culture conversion, while only the higher BMI (aHR = 1.10, 1.03 – 1.18) was associated with rapid smear conversion. The predicted risk score from independent predictors showed good discrimination (0.855 ± 0.023 and 0.883 ± 0.02 respectively for smear and culture conversions). Time-to initial culture conversion provided a better discriminative capacity (AUC) to detect patients with higher chance to being treatment success during the first three months.Conclusion The identified predictors can be considered to improve the management of MDR-TB patients. The optimal time points for culture conversion was three months in shorter regime. Keywords: Conversion, Multidrug-resistant, Tuberculosis, Guinea.

Abstract Background: Despite the availability of the drug treatment for tuberculosis (TB) more than 75 years, mortality and drug resistance are increasing. Therefore, little data is available in Guinea. We aimed to develop and validate a prognosis nomogram of MDR-TB treatment outcomes. Methods:A retrospective cohort study was conducted among men and women, aged 18 years or older, with MDR-TB, from three major drug-resistance TB centres in Guinea. We used the logistic regression to analyse treatment outcomes. Prognostic factors with a p value less than 0.05 from a multivariate model were used to build nomogram and assessed their performance based on discriminative c-index, and calibration using the Hosmer-Lemeshow (H-L) test. To derive the optimal cut-off point score, the Youden’s index method was used. Results:Among 232 patients with MDR-TBenrolled and followed between June 07, 2016 and June 22, 2018, 218 were analyzed. All patients were resistant to rifampicin, which diagnosed by the Xpert MTB/RIF. The overall rate of success was 73%.Factors associated with successful treatment in drug-resistant TB patients were higher BMI more than 18.5 kg/m2(p = 0.0253; aOR = 2.94), good adherence to treatment (p = < 0.0001; aOR = 33.92), normal platelets count (p = 0.0053; OR = 1.004), and the absence of clinical symptoms such as chest pain (p = 0.0083; aOR = 3.19) and depression (p = 0.0308; aOR = 8.62). The discrimination (c-index= 0.848 [95% bootstrap CI, 0.780 – 0.916] in the derivation sample and 0.803 after correction for optimism) and calibration (H-LX2= 2.91 [p = 0.94]) were good. The optimal absolute risk threshold was 20%, corresponding to a sensibility of 95% and specificity of 58%. Conclusion:Treatment success outcomes was lower than those recommended by the World Health Organization (75%). We recommend to improve the MDR-TB patient monitoring during treatment, nutritional status, and considering the psychological state. Our prognosis nomogram needs to be validated in an external population before it can be used in clinical practice. Keywords:Nomogram, Multidrug-resistant, Tuberculosis, Guinea.

Background: Sputum smear and culture examination were used as bacteriological marker to monitor multidrug-resistant tuberculosis (MDR-TB) treatment. We aimed to identify the strongest contributing factors that affect time-to sputum bacteriological conversion, and to develop a practical risk score. Methods: Patients treated with shorter MDR-TB treatment regime between June 07, 2016 and June 22, 2018 from three major drug-resistance TB centres in Guinea, who had a positive smear or culture at baseline, and who had rifampicin resistance were analysed. Sputum bacteriological conversion was defined as two consecutive negative smear or culture taken at least 30 days apart. Cox regression model was used to analyse time-to initial sputum conversion, and to identify influencing factors. A simple risk score was constructed using the regression coefficients from each final model. Time-dependent AUC was used to determine the optimal time points of bacteriological conversion. Results: 75% (173/232) of patients with a positive smear and culture at baseline were analyzed. A total, 90.2% (156/173) and 89% (154/173) of the patients had smear and culture conversions in a median of 59 days (inter-quartile range: 59–61) respectively. Lower colony count (

Despite the availability of the drug treatment for tuberculosis (TB) more than 75 years, mortality and drug resistance are increasing. Therefore, little data is available in Guinea. We aimed to develop and validate a prognosis nomogram of MDR-TB treatment outcomes. A retrospective cohort study was conducted among men and women, aged 18 years or older, with MDR-TB, from three major drug-resistance TB centres in Guinea. We used the logistic regression to analyse treatment outcomes. Prognostic factors with a p value less than 0.05 from a multivariate model were used to build nomogram and assessed their performance based on discriminative c-index, and calibration using the Hosmer-Lemeshow (H-L) test. To derive the optimal cut-off point score, the Youden’s index method was used. Among 232 patients with MDR-TB enrolled and followed between June 07, 2016 and June 22, 2018, 218 were analyzed. All patients were resistant to rifampicin, which diagnosed by the Xpert MTB/RIF. The overall rate of success was 73%. Factors associated with successful treatment in drug-resistant TB patients were higher BMI more than 18.5 kg/m2 (p = 0.0253; aOR = 2.94), good adherence to treatment (p = < 0.0001; aOR = 33.92), normal platelets count (p = 0.0053; OR = 1.004), and the absence of clinical symptoms such as chest pain (p = 0.0083; aOR = 3.19) and depression (p = 0.0308; aOR = 8.62). The discrimination (c-index = 0.848 [95% bootstrap CI, 0.780 – 0.916] in the derivation sample and 0.803 after correction for optimism) and calibration (H-LX2 = 2.91 [p = 0.94]) were good. The optimal absolute risk threshold was 20%, corresponding to a sensibility of 95% and specificity of 58%. Treatment success outcomes was lower than those recommended by the World Health Organization (75%). We recommend to improve the MDR-TB patient monitoring during treatment, nutritional status, and considering the psychological state. Our prognosis nomogram needs to be validated in an external population before it can be used in clinical practice.

Purpose: The aim of this study was to determine the epidemiological, lesion, treatment and outcome of the 'floating elbow' in children. Observations: It was two boys and a girl with a mean age of 7 years. The average consultation time was 3.6 h. In two patients, the trauma had occurred during playful accident with fall from a height. Supracondylar fracture was associated with a fracture epiphyseal separation-type II distal end of the right radius in one case, a fracture of the distal quarter of the bones 2 of the forearm in the second patient and fracture quarter distal radius in the third patient. All fractures of the elbow were treated by osteosynthesis as well as a fracture of the distal radius ¼. The average hospital stay was 5 days. After a mean of 8 months was rated limitation of elbow flexion to 100° in a patient, an externalisation of the pins at the elbow in M3 in one patient and a limitation of elbow extension at 30° in 2 patients. One patient had a varus ulna. The pronosupination was preserved in all patients. Conclusion: The 'floating elbow' is unusual in children and usually occurs during a high-energy trauma. His treatment is not yet the subject of consensus. Complications often involve the elbow.

Introduction: Les accidents de scooter sont de plus en plus fréquents à Dakar. Le but de ce travail est de rapporter les aspects épidémiologiques et lésionnels des ces accidents chez l'enfant à Dakar. Méthodes: Une étude rétrospective et descriptive a été menée dans le Service de Chirurgie Pédiatrique du CHU Aristide Le Dantec de Dakar entre le 1er janvier 2009 et le 31 décembre 2011. Nous avons étudié divers paramètres dont la fréquence, les aspects sociodémographiques et lésionnels. Résultats: Les accidents de scooter représentaient 12 % des accidents de la voie publique. Ils étaient fréquents entre 12 heures et 14 heures (27 %) et entre 18 heures et 20 heures (28,4 %). Ils pouvaient survenir tous les jours et étaient fréquents pendant les mois d'avril (17,6 %) et de juin (13,5 %). Ils survenaient essentiellement dans la périphérie de Dakar (78 %). La tranche de 3 à 8 ans (60,8 %) était la plus touchée. Le sexe masculin était prédominant (sexe ratio de 1,5). Les piétons étaient les plus vulnérables (93,2 %). La chute était le mécanisme dominant (98,7 %). Les lésions touchaient surtout le membre inférieur (51,1 %) et étaient constituées essentiellement de fracture. Conclusion: La fréquence des accidents de scooter chez l'enfant est liée à l'urbanisation galopante et à l'accroissement du parc automobile dans une presqu'île. Les victimes sont essentiellement des piétons et présentent le plus souvent des fractures.Key words: Accident de scooter, enfant, piétons, fractures, Dakar

Introduction Les accidents de scooter sont de plus en plus fréquents à Dakar. Le but de ce travail est de rapporter les aspects épidémiologiques et lésionnels des ces accidents chez l'enfant à Dakar. Méthodes Une étude rétrospective et descriptive a été menée dans le Service de Chirurgie Pédiatrique du CHU Aristide Le Dantec de Dakar entre le 1er janvier 2009 et le 31 décembre 2011. Nous avons étudié divers paramètres dont la fréquence, les aspects sociodémographiques et lésionnels. Résultats Les accidents de scooter représentaient 12% des accidents de la voie publique. Ils étaient fréquents entre 12 heures et 14 heures (27%) et entre 18 heures et 20 heures (28,4%). Ils pouvaient survenir tous les jours et étaient fréquents pendant les mois d'avril (17,6%) et de juin (13,5%). Ils survenaient essentiellement dans la périphérie de Dakar (78%). La tranche de 3 à 8 ans (60,8%) était la plus touchée. Le sexe masculin était prédominant (sexe ratio de 1,5). Les piétons étaient les plus vulnérables (93,2%). La chute était le mécanisme dominant (98,7%). Les lésions touchaient surtout le membre inférieur (51,1%) et étaient constituées essentiellement de fracture. Conclusion La fréquence des accidents de scooter chez l'enfant est liée à l'urbanisation galopante et à l'accroissement du parc automobile dans une presqu’île. Les victimes sont essentiellement des piétons et présentent le plus souvent des fractures.

We argue that designing any aspect of information technology requires an understanding of sociotechnical gaps. These gaps are inherent issues deriving from the difference between what is required socially, or culturally, and what can be done technically. In the context of a British-Kenyan project, we introduce an approach for addressing sociotechnical gaps in the design and deployment of digital resources in resource-constrained and culturally different environments. We illustrate how despite having an online, asynchronous tool to visualise sociotechnical gaps among different stakeholders in a design team, we had to complement it with a pen and paper design metaphor elucidation exercise to elicit and visualise locally meaningful user interface elements.

The frequency of posterior sternoclavicular dislocations represents 0.019% of the shoulder injuries in the Centre of Traumatology and Orthopedics of Dakar. The posterior form is 0.033% compared to the anterior form. The authors report the cases of posterior sternoclavicular dislocations, occurred with seven men and one woman. Seven of these dislocations were located on the left side, including one case of polytraumatism, one associated with a brachial plexus compression, and one case with a fracture of the kneecap. The authors show the interest of the incidence of Heinig in the diagnosis. The open treatment following the technique of burrows which uses the tendon of the subclavius gives satisfactory results in both functional and anatomical respects. They discuss the orthopaedic methods and insist on their disadvantages, especially in the event of vascular lesion with a risk of haemorrhage of a clogged breach or source of instability, and the difficulty of radiological control after reduction.

This paper presents an offline mobile eLearning concept as an ICT solution to address the knowledge requirements of a rural sub-Saharan farming community. A socio-technical customisation and deployment of WikiReaders is proposed to support offline mobile access to digital content. A future use scenario is presented as a demonstration of cheap but sustainable innovation emerging from a longitudinal evaluation of users, their needs and their context.

This paper proposes a socio-technical approach to making explicit cultural issues in collaborative and multidisciplinary teams in information system design. Requirements and design processes of international, multicultural and multidisciplinary partners are put through a series of socio-technical experiments and evaluated to develop and refine a conceptual tool: socio-technical evaluation matrices (STEM). STEM has provided a platform to effectively explore, explicate and reflect on cultural and contextual implications in design processes among stakeholders (including end users).

Sub-Saharan African communities are classified as collectivist societies. But, what exactly is meant by collectivism and to what extent individuals adhere to this given the differences in their socio-economic conditions? This paper is an empirical exploration of the contextual and cultural traits of a rural sub-Saharan African community in order to facilitate their interpretation towards technology design and adoption. Card sorting is used to validate and make explicit contextual and cultural traits previously identified during interviews. It is a confirmation of the collectivist nature of these cultures with more details such as eagerness to confirm personal views and requirements with that of the group in order to save “face”, among other traits.

International audience; This paper offers context and culture elicitation in an inter-cultural and multi-disciplinary setting of ICT design. Localised usability evaluation (LUE) is augmented with a socio-technical evaluation tool (STEM) as a methodological approach to expose and address issues in a collaborative ICT design within the Village e-Science for Life (VeSeL) project in rural Kenya. The paper argues that designers need to locally identify context and culture in situ and further explicate their implications through the design process and at the global level. Stakeholders' context, culture, decisions, agendas, expectations, disciplines and requirements need to be locally identified and globally evaluated to ensure a fit for purpose solution.

STEM is an interactive web application designed to support and facilitate socio-technical discussions in a collaborative environment. This interactive demo shows how STEM aims to encompass issues with collaborative tools such as organisation of discussion threads by relevancy, interdependency and iteration of previous discussions.

This article describes how the VeSeL project which involves a distributed team of technologists and users from different cultural backgrounds is attempting to manage the process of user involvement and participation. In this case the developers are distributed but linked by a number of communication technologies while the users have very few technological means of communicating with the developers. It describes how the contrasting social and community issues of both the developers and the users can be understood and managed.